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Coronary Artery Ectasia Predicts Future Cardiac Events in Patients With Acute Myocardial Infarction
Takahito Doi1, Yu Kataoka2, Teruo Noguchi1
1From the Department of Cardiovascular Medicine (T.D., Y.K., T. Noguchi, T. Nakashima, S.K., K. Nakao, M.F., T. Nagai, T.K., Y.T., Y.A., T.A., K.K., Y.G., S.Y.), Department of Pediatric Cardiology (E.T.), and Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (M.N., K.N.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Advanced Cardiovascular Medicine (T.D., S.Y.) and Department of Cardiovascular Medicine (H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan; and Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Japan (T.S.).
Insights
Coronary artery ectasia (CAE) significantly increases the risk of major adverse cardiac events, including cardiac death and myocardial infarction, in patients with acute myocardial infarction. Optimal anticoagulation therapy may mitigate these risks in high-risk CAE patients.
Area of Science:
- Cardiology
- Vascular Biology
- Clinical Outcomes Research
Background:
- Coronary artery ectasia (CAE) is a vascular condition involving abnormal vessel dilation.
- The impact of CAE on cardiovascular outcomes, particularly in acute myocardial infarction (MI) patients, remains unclear.
- CAE may promote thrombogenicity and inflammation, potentially affecting cardiac events.
Purpose of the Study:
- To investigate the association between coronary artery ectasia (CAE) and major adverse cardiac events (MACE) in patients with acute myocardial infarction (MI).
- To determine if CAE is an independent predictor of future cardiac events in this patient population.
- To explore the potential benefits of anticoagulation therapy in mitigating MACE in patients with CAE.
Main Methods:
- A cohort study of 1698 patients with acute MI was conducted.
- Patients were categorized based on the presence or absence of CAE.
- Major adverse cardiac events (MACE), including cardiac death and nonfatal MI, were tracked over a 49-month period.
- Multivariate Cox proportional hazards models and propensity score-matched analyses were used to assess the risk associated with CAE.
- The impact of anticoagulation therapy and time in therapeutic range was evaluated in patients with CAE.
Main Results:
- Coronary artery ectasia (CAE) was identified in 3.0% of the study cohort.
- Patients with CAE exhibited significantly higher risks of MACE (3.25-fold), cardiac death (2.71-fold), and nonfatal MI (4.92-fold) compared to those without CAE.
- These associations remained significant after adjusting for other risk factors in multivariate and propensity score-matched analyses.
- Patients with CAE who received anticoagulation therapy and achieved optimal time in therapeutic range (≥60%) did not experience MACE.
Conclusions:
- The presence of CAE is a significant predictor of adverse cardiovascular events in patients with acute MI.
- Acute MI patients with CAE represent a high-risk subgroup.
- Pharmacological management targeting the coagulation cascade, such as optimal anticoagulation, may be beneficial for patients with CAE to reduce cardiac event occurrence.
Objective:
Coronary artery ectasia (CAE) is an infrequently observed vascular phenotype characterized by abnormal vessel dilatation and disturbed coronary flow, which potentially promote thrombogenicity and inflammatory reactions. However, whether or not CAE influences cardiovascular outcomes remains unknown.
Approach And Results:
We investigated major adverse cardiac events (MACE; defined as cardiac death and nonfatal myocardial infarction [MI]) in 1698 patients with acute MI. The occurrence of MACE was compared in patients with and without CAE. CAE was identified in 3.0% of study subjects. During the 49-month observation period, CAE was associated with 3.25-, 2.71-, and 4.92-fold greater likelihoods of experiencing MACE (95% confidence interval [CI], 1.88-5.66; P<0.001), cardiac death (95% CI, 1.37-5.37; P=0.004), and nonfatal MI (95% CI, 2.20-11.0; P<0.001), respectively. These cardiac risks of CAE were consistently observed in a multivariate Cox proportional hazards model (MACE: hazard ratio, 4.94; 95% CI, 2.36-10.4; P<0.001) and in a propensity score-matched cohort (MACE: hazard ratio, 8.98; 95% CI, 1.14-71.0; P=0.03). Despite having a higher risk of CAE-related cardiac events, patients with CAE receiving anticoagulation therapy who achieved an optimal percent time in target therapeutic range, defined as ≥60%, did not experience the occurrence of MACE (P=0.03 versus patients with percent time in target therapeutic range <60% or without anticoagulation therapy).
Conclusions:
The presence of CAE predicted future cardiac events in patients with acute MI. Our findings suggest that acute MI patients with CAE are a high-risk subset who might benefit from a pharmacological approach to controlling the coagulation cascade.
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